Hammersmith Infant Neurological Examination Asymmetry Score Distinguishes Hemiplegic Cerebral Palsy From Typical Development

Hay, Krystal; Nelin, Mary Ann; Carey, Helen; Chorna, Olena; Mas, Melissa Moore-Clingenpeel Ma; Maitre, Nathalie L.

doi:10.1016/j.pediatrneurol.2018.07.002

Cited by 39 publications

(46 citation statements)

References 13 publications

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“…The HINE allows early detection of typology of CP and additionally provides a longitudinal evaluation of impairment severity in infants (before the Gross Motor Function Classification System can be reliably ascertained). 26 Reliance on rigorous examination and reevaluation of organizational processes in HRIF settings contributed to the success of the project and trust from institutional supports. Process metrics revealed increased frequency of 3-to 4-month visits, allowing for more consistent use of the GMA at fidgety age, when sensitivity and specificity for CP are highest.…”

Section: Discussionmentioning

confidence: 99%

Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis

Maitre¹,

Burton²,

Duncan³

et al. 2020

Pediatrics

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BACKGROUND AND OBJECTIVES: Early diagnosis of cerebral palsy (CP) is critical in obtaining evidence-based interventions when plasticity is greatest. In 2017, international guidelines for early detection of CP were published on the basis of a systematic review of evidence. Our study aim was to reduce the age at CP diagnosis throughout a network of 5 diverse US high-risk infant follow-up programs through consistent implementation of these guidelines. METHODS:The study leveraged plan-do-study-act and Lean methodologies. The primary outcome was age at CP diagnosis. Data were acquired during the corresponding 9-month baseline and quarterly throughout study. Balancing measures were clinic no-show rates and parent perception of the diagnosis visit. Clinic teams conducted strengths, weaknesses, opportunities, and threats analyses, process flow evaluations, standardized assessments training, and parent questionnaires. Performance of a 3-to 4-month clinic visit was a critical process step because it included a Hammersmith Infant Neurologic Examination, a General Movements Assessment, and standardized assessments of motor function. RESULTS:The age at CP diagnosis decreased from a weighted average of 19.5 (95% confidence interval 16.2 to 22.8) to 9.5 months (95% confidence interval 4.5 to 14.6), with P = .008; 3-to 4-month visits per site increased from the median (interquartile range) 14 (5.2-73.7) to 54 (34.5-152.0), with P , .001; and no-show rates were not different. Parent questionnaires revealed positive provider perception with improvement opportunities for information content and understandability.CONCLUSIONS: Large-scale implementation of international guidelines for early detection of CP is feasible in diverse high-risk infant follow-up clinics. The initiative was received positively by families and without adversely affecting clinic operational flow. Additional parent support and education are necessary.

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Section: Discussionmentioning

confidence: 99%

Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis

Maitre¹,

Burton²,

Duncan³

et al. 2020

Pediatrics

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“…This model shows the best predictive value for unilateral CP to date, but is not yet available clinically. A HINE score <63 in combination with >5 congruent asymmetries has low quality but emerging evidence for predicting unilateral CP from typical development (sensitivity 91.8% (95% CI 83%–96%), specificity 100% (95% CI 0.95–1.0), median age 15 months) [75]. Term equivalent age MRI findings also have value in predicting topography of CP in both preterm and term born infants [14].…”

Section: Current State Of Early Classification Of Cp Under Two Yeamentioning

confidence: 99%

Early Diagnosis and Classification of Cerebral Palsy: An Historical Perspective and Barriers to an Early Diagnosis

Velde

Morgan

Novak

et al. 2019

JCM

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Since the 1800s, there have been calls in the literature for the early diagnosis of cerebral palsy (CP). However, diagnosis still often occurs late, from 12 to 24 months in high income countries and as late as 5 years in low resource settings. This is after the optimal timeframe for applying interventions which could harness neuroplastic potential in the developing brain. Multiple barriers exist which affect clinicians’ confidence in diagnosing CP early. These range from the lack of definitive biomarkers to a lack of curative treatments for CP. Further barriers to diagnosis are proposed including; (a) difficulty finding a congruent fit with the definition of CP in an infant, where expected activity limitations might not yet be apparent; and (b) differences in the presentation of motor type and topography classifications between infants and children. These barriers may affect a clinicians’ confidence using “pattern recognition” in the differential diagnosis process. One of the central tenets of this paper is that diagnosis and classification are different, involving different instruments, and are more accurately conducted separately in infants, whereas they are fundamentally interconnected in older children and inform therapeutic decisions. Furthermore, we need to be careful not to delay early diagnosis because of the low reliability of early classification, but instead uncouple these two processes. Ongoing implementation of best practice for early detection requires creative solutions which might include universal screening for CP. Implementation and accompanying knowledge translation studies are underway to decrease the average age of diagnosis in CP.

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“…Inclusion criteria were a neurological impairment with more than five asymmetries on the Hammersmith Infant Neurological Examination, shown to be associated with later CP. 11 In addition, all participants had functional differences between their upper extremities based on the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), fine motor scales, administered as detailed below. Exclusion criteria included Gross Motor Function Classification System (GMFCS) level V (due to poor motor control of proximal upper extremity muscle groups necessary for arm use), botulinum neurotoxin A injections in the upper extremities within 3 months of study entry, or congenital brain malformations.…”

Section: Methods Participantsmentioning

confidence: 99%

Caregiver perception of hand function in infants with cerebral palsy: psychometric properties of the Infant Motor Activity Log

Carey

Hay

Nelin

et al. 2020

Develop Med Child Neuro

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To evaluate the properties of the Infant Motor Activity Log (IMAL), a caregiver-report for frequency and quality of use of more affected upper extremity in infants with neurological and functional impairments. METHOD This was a prospective cohort study of 66 children (34 females, 32 males) aged 6 to 24 months (mean age [SD] 13.7mo [5.3]) with neurological and functional impairments and a confirmed cerebral palsy diagnoses after 2 years, and 51 age-matched typically developing children. The IMAL was administered at baseline and 4 weeks later. Typically developing infants were tested with randomly assigned 'more affected' upper extremity. Psychometric properties were evaluated using Spearman's correlation coefficient, Cronbach's alpha, and Jonckheere-Terpstra tests. RESULTS In the children with impairments, the IMAL showed internal consistency (alpha≥0.88) for the How Well Scale (HWS) and How Often Scale (HOS). Test-retest reliability was 0.64 (HOS) and 0.70 (HWS), demonstrating stability over time. Correlation with Bayley Scales of Infant and Toddler Development, Third Edition more affected arm raw scores were 0.70 (HOS) and 0.72 (HWS) (p<0.001) demonstrating construct validity. Both scale scores decreased with increasing Gross Motor Function Classification System and Mini-Manual Ability Classification System (p<0.001) levels, supporting discriminative validity. Discrimination between typically developing infants and infants with impairments was high (HWS: area under the receiver operating characteristic curve [AUC] 0.96, 95% confidence interval [CI] 0.94-0.99 and HOS AUC=0.95, CI 0.92-0.99). INTERPRETATION The IMAL is a valid and reliable discriminative caregiver measure of upper limb performance and may complement measures of capacity in infants with neurological and functional impairments.

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Hammersmith Infant Neurological Examination Asymmetry Score Distinguishes Hemiplegic Cerebral Palsy From Typical Development

Abstract: In a clinical setting, combining total Hammersmith Infant Neurological Examination and asymmetry scores can help providers differentiate infants with hemiplegia from those typically developing.

Cited by 39 publications

References 13 publications

Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis

Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis

Early Diagnosis and Classification of Cerebral Palsy: An Historical Perspective and Barriers to an Early Diagnosis

Caregiver perception of hand function in infants with cerebral palsy: psychometric properties of the Infant Motor Activity Log

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